Healthcare Provider Details

I. General information

NPI: 1194141333
Provider Name (Legal Business Name): MICHAEL BLACKMER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2014
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1711 N MCKENZIE ST STE 100
FOLEY AL
36535-2282
US

IV. Provider business mailing address

PO BOX 86144
MOBILE AL
36689-6144
US

V. Phone/Fax

Practice location:
  • Phone: 251-476-5050
  • Fax:
Mailing address:
  • Phone: 251-476-5050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License NumberDO.2305
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: